Official Chuck Liddell Website Fan Club Reistration

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Member Name and Password:</h2> <ul> <li> <label for="email">Email:</label> <input type="text" name="email" id="email" onchange="changeEmail()" onkeyup="this.onchange()" value=""/> </li> <li> <label for="emailconfirm">Confirm Email:</label> <input type="text" name="emailconfirm" id="emailconfirm" onchange="changeEmail()" onkeyup="this.onchange()" value=""/> <div id="email_warning" class="verify_warning"> <div id="email_good" style="display: none;" title="Valid email"></div> <div id="email_bad" style="display: none;" title="Invalid / Unconfirmed email"></div> </div> </li> <li> <label for="password">Password:</label> <input type="password" name="password" id="password" onchange="changePassword()" onkeyup="this.onchange()" value=""/> </li> <li> <label for="password">Confirm Password:</label> <input type="password" name="confirm" id="confirm" onchange="changePassword()" onkeyup="this.onchange()" value=""/> <div id="password_warning" class="verify_warning"> <div id="password_good" style="display: none;" title="Valid password"></div> <div id="password_bad" style="display: none;" title="Invalid password"></div> </div> </li> <li> <label for="displayname">Display Name:</label> <input type="text" name="display_name" id="displayname" onchange="changeDisplayName()" onkeyup="this.onchange()" value=""/> <div id="display_warn" class="verify_warning" style="display: none;" title="Invalid character"></div> </li> </ul> <p></p> </div> <div class="info section"> <h2>2. Member Information</h2> <ul> <li class="birthdate"> <label for="birth_year">*Date of Birth:</label> <select name="birth_month" id="birth_month"> <option value="1">Jan</option> <option value="2">Feb</option> <option value="3">Mar</option> <option value="4">Apr</option> <option value="5">May</option> <option value="6">Jun</option> <option value="7">Jul</option> <option value="8">Aug</option> <option value="9">Sep</option> <option value="10">Oct</option> <option value="11">Nov</option> <option value="12">Dec</option> </select> <select name="birth_day" id="birth_day"> <option value="1">1</option> <option value="2">2</option> <option value="3">3</option> <option value="4">4</option> <option value="5">5</option> <option value="6">6</option> <option value="7">7</option> <option value="8">8</option> <option value="9">9</option> <option value="10">10</option> <option value="11">11</option> <option value="12">12</option> <option value="13">13</option> <option value="14">14</option> <option value="15">15</option> <option value="16">16</option> <option value="17">17</option> <option value="18">18</option> <option value="19">19</option> <option value="20">20</option> <option value="21">21</option> <option value="22">22</option> <option value="23">23</option> <option value="24">24</option> <option value="25">25</option> <option value="26">26</option> <option value="27">27</option> <option value="28">28</option> <option value="29">29</option> <option value="30">30</option> <option value="31">31</option> </select> <select name="birth_year" id="birth_year"> <option value="2007">2007</option> <option value="2006">2006</option> <option value="2005">2005</option> <option value="2004">2004</option> <option value="2003">2003</option> <option value="2002">2002</option> <option value="2001">2001</option> <option value="2000">2000</option> <option value="1999">1999</option> <option value="1998">1998</option> <option value="1997">1997</option> <option value="1996">1996</option> <option value="1995">1995</option> <option value="1994">1994</option> <option value="1993">1993</option> <option value="1992">1992</option> <option value="1991">1991</option> <option value="1990">1990</option> <option value="1989">1989</option> <option value="1988">1988</option> <option value="1987">1987</option> <option value="1986">1986</option> <option value="1985">1985</option> <option value="1984">1984</option> <option value="1983">1983</option> <option value="1982">1982</option> <option value="1981">1981</option> <option value="1980">1980</option> <option value="1979">1979</option> <option value="1978">1978</option> <option value="1977">1977</option> <option value="1976">1976</option> <option value="1975">1975</option> <option value="1974">1974</option> <option value="1973">1973</option> <option value="1972">1972</option> <option value="1971">1971</option> <option value="1970">1970</option> <option value="1969">1969</option> <option value="1968">1968</option> <option value="1967">1967</option> <option value="1966">1966</option> <option value="1965">1965</option> <option value="1964">1964</option> <option value="1963">1963</option> <option value="1962">1962</option> <option value="1961">1961</option> <option value="1960">1960</option> <option value="1959">1959</option> <option value="1958">1958</option> <option value="1957">1957</option> <option value="1956">1956</option> <option value="1955">1955</option> <option value="1954">1954</option> <option value="1953">1953</option> <option value="1952">1952</option> <option value="1951">1951</option> <option value="1950">1950</option> <option value="1949">1949</option> <option value="1948">1948</option> <option value="1947">1947</option> <option value="1946">1946</option> <option value="1945">1945</option> <option value="1944">1944</option> <option value="1943">1943</option> <option value="1942">1942</option> <option value="1941">1941</option> <option value="1940">1940</option> <option value="1939">1939</option> <option value="1938">1938</option> <option value="1937">1937</option> <option value="1936">1936</option> <option value="1935">1935</option> <option value="1934">1934</option> <option value="1933">1933</option> <option value="1932">1932</option> <option value="1931">1931</option> <option value="1930">1930</option> <option value="1929">1929</option> <option value="1928">1928</option> <option value="1927">1927</option> <option value="1926">1926</option> <option value="1925">1925</option> <option value="1924">1924</option> <option value="1923">1923</option> <option value="1922">1922</option> <option value="1921">1921</option> <option value="1920">1920</option> <option value="1919">1919</option> <option value="1918">1918</option> <option value="1917">1917</option> <option value="1916">1916</option> <option value="1915">1915</option> <option value="1914">1914</option> <option value="1913">1913</option> <option value="1912">1912</option> <option value="1911">1911</option> <option value="1910">1910</option> <option value="1909">1909</option> <option value="1908">1908</option> <option value="1907">1907</option> <option value="1906">1906</option> <option value="1905">1905</option> <option value="1904">1904</option> <option value="1903">1903</option> <option value="1902">1902</option> <option value="1901">1901</option> <option value="1900">1900</option> </select> </li> <li class="gender"> <label for="gender">Gender:</label> <select id="gender" name="gender"> <option value=""></option> <option value="Male">Male</option> <option value="Female">Female</option> </select> </li> <li class="country"> <label for="country">Country:</label> <select id="country" name="country" onchange="changeCountry(this.value)" onkeyup="this.onchange()"> <option value="US">United States</option> <option value="">----------------</option> <option value="AF">Afghanistan</option> <option value="AX">Aland Islands</option> <option value="AL">Albania</option> <option value="DZ">Algeria</option> <option value="AS">American Samoa</option> <option value="AD">Andorra</option> <option value="AO">Angola</option> <option value="AI">Anguilla</option> <option value="AQ">Antarctica</option> <option value="AG">Antigua and Barbuda</option> <option value="AR">Argentina</option> <option value="AM">Armenia</option> <option value="AW">Aruba</option> <option value="AU">Australia</option> <option value="AT">Austria</option> <option value="AZ">Azerbaijan</option> <option value="BS">Bahamas</option> <option value="BH">Bahrain</option> <option value="BD">Bangladesh</option> <option value="BB">Barbados</option> <option value="BY">Belarus</option> <option value="BE">Belgium</option> <option value="BZ">Belize</option> <option value="BJ">Benin</option> <option value="BM">Bermuda</option> <option value="BT">Bhutan</option> <option value="BO">Bolivia</option> <option value="BA">Bosnia and Herzegovina</option> <option value="BW">Botswana</option> <option value="BV">Bouvet Island</option> <option value="BR">Brazil</option> <option value="IO">British Indian Ocean Territory</option> <option value="BN">Brunei Darussalam</option> <option value="BG">Bulgaria</option> <option value="BF">Burkina Faso</option> <option value="BI">Burundi</option> <option value="KH">Cambodia</option> <option value="CM">Cameroon</option> <option value="CA">Canada</option> <option value="CV">Cape Verde</option> <option value="KY">Cayman Islands</option> <option value="CF">Central African Republic</option> <option value="TD">Chad</option> <option value="CL">Chile</option> <option value="CN">China</option> <option value="CX">Christmas Island</option> <option value="CC">Cocos (Keeling) Islands</option> <option value="CO">Colombia</option> <option value="KM">Comoros</option> <option value="CD">Congo</option> <option value="CG">Congo</option> <option value="CK">Cook Islands</option> <option value="CR">Costa Rica</option> <option value="CI">Cote d'Ivoire</option> <option value="HR">Croatia</option> <option value="CU">Cuba</option> <option value="CY">Cyprus</option> <option value="CZ">Czech Republic</option> <option value="DK">Denmark</option> <option value="DJ">Djibouti</option> <option value="DM">Dominica</option> <option value="DO">Dominican Republic</option> <option value="EC">Ecuador</option> <option value="EG">Egypt</option> <option value="SV">El Salvador</option> <option value="GQ">Equatorial Guinea</option> <option value="ER">Eritrea</option> <option value="EE">Estonia</option> <option value="ET">Ethiopia</option> <option value="FK">Falkland Islands (Malvinas)</option> <option value="FO">Faroe Islands</option> <option value="FJ">Fiji</option> <option value="FI">Finland</option> <option value="FR">France</option> <option value="GF">French Guiana</option> <option value="PF">French Polynesia</option> <option value="TF">French Southern Territories</option> <option value="GA">Gabon</option> <option value="GM">Gambia</option> <option value="GE">Georgia</option> <option value="DE">Germany</option> <option value="GH">Ghana</option> <option value="GI">Gibraltar</option> <option value="GR">Greece</option> <option value="GL">Greenland</option> <option value="GD">Grenada</option> <option value="GP">Guadeloupe</option> <option value="GU">Guam</option> <option value="GT">Guatemala</option> <option value="GG">Guernsey</option> <option value="GN">Guinea</option> <option value="GW">Guinea-Bissau</option> <option value="GY">Guyana</option> <option value="HT">Haiti</option> <option value="HM">Heard Island and McDonald Islands</option> <option value="VA">Holy See (Vatican City State)</option> <option value="HN">Honduras</option> <option value="HK">Hong Kong</option> <option value="HU">Hungary</option> <option value="IS">Iceland</option> <option value="IN">India</option> <option value="ID">Indonesia</option> <option value="IR">Iran</option> <option value="IQ">Iraq</option> <option value="IE">Ireland</option> <option value="IM">Isle of Man</option> <option value="IL">Israel</option> <option value="IT">Italy</option> <option value="JM">Jamaica</option> <option value="JP">Japan</option> <option value="JE">Jersey</option> <option value="JO">Jordan</option> <option value="KZ">Kazakhstan</option> <option value="KE">Kenya</option> <option value="KI">Kiribati</option> <option value="KW">Kuwait</option> <option value="KG">Kyrgyzstan</option> <option value="LA">Lao People's Democratic Republic</option> <option value="LV">Latvia</option> <option value="LB">Lebanon</option> <option value="LS">Lesotho</option> <option value="LR">Liberia</option> <option value="LY">Libyan Arab Jamahiriya</option> <option value="LI">Liechtenstein</option> <option value="LT">Lithuania</option> <option value="LU">Luxembourg</option> <option value="MO">Macao</option> <option value="MK">Macedonia</option> <option value="MG">Madagascar</option> <option value="MW">Malawi</option> <option value="MY">Malaysia</option> <option value="MV">Maldives</option> <option value="ML">Mali</option> <option value="MT">Malta</option> <option value="MH">Marshall Islands</option> <option value="MQ">Martinique</option> <option value="MR">Mauritania</option> <option value="MU">Mauritius</option> <option value="YT">Mayotte</option> <option value="MX">Mexico</option> <option value="FM">Micronesia</option> <option value="MD">Moldova</option> <option value="MC">Monaco</option> <option value="MN">Mongolia</option> <option value="ME">Montenegro</option> <option value="MS">Montserrat</option> <option value="MA">Morocco</option> <option value="MZ">Mozambique</option> <option value="MM">Myanmar</option> <option value="NA">Namibia</option> <option value="NR">Nauru</option> <option value="NP">Nepal</option> <option value="NL">Netherlands</option> <option value="AN">Netherlands Antilles</option> <option value="NC">New Caledonia</option> <option value="NZ">New Zealand</option> <option value="NI">Nicaragua</option> <option value="NE">Niger</option> <option value="NG">Nigeria</option> <option value="NU">Niue</option> <option value="NF">Norfolk Island</option> <option value="KP">North Korea</option> <option value="MP">Northern Mariana Islands</option> <option value="NO">Norway</option> <option value="OM">Oman</option> <option value="PK">Pakistan</option> <option value="PW">Palau</option> <option value="PS">Palestinian Territory</option> <option value="PA">Panama</option> <option value="PG">Papua New Guinea</option> <option value="PY">Paraguay</option> <option value="PE">Peru</option> <option value="PH">Philippines</option> <option value="PN">Pitcairn</option> <option value="PL">Poland</option> <option value="PT">Portugal</option> <option value="PR">Puerto Rico</option> <option value="QA">Qatar</option> <option value="RE">Reunion</option> <option value="RO">Romania</option> <option value="RU">Russian Federation</option> <option value="RW">Rwanda</option> <option value="BL">Saint Barthelemy</option> <option value="SH">Saint Helena</option> <option value="KN">Saint Kitts and Nevis</option> <option value="LC">Saint Lucia</option> <option value="MF">Saint Martin (French part)</option> <option value="PM">Saint Pierre and Miquelon</option> <option value="VC">Saint Vincent and the Grenadines</option> <option value="WS">Samoa</option> <option value="SM">San Marino</option> <option value="ST">Sao Tome and Principe</option> <option value="SA">Saudi Arabia</option> <option value="SN">Senegal</option> <option value="RS">Serbia</option> <option value="SC">Seychelles</option> <option value="SL">Sierra Leone</option> <option value="SG">Singapore</option> <option value="SK">Slovakia</option> <option value="SI">Slovenia</option> <option value="SB">Solomon Islands</option> <option value="SO">Somalia</option> <option value="ZA">South Africa</option> <option value="GS">South Georgia / South Sandwich Islands</option> <option value="KR">South Korea</option> <option value="ES">Spain</option> <option value="LK">Sri Lanka</option> <option value="SD">Sudan</option> <option value="SR">Suriname</option> <option value="SJ">Svalbard and Jan Mayen</option> <option value="SZ">Swaziland</option> <option value="SE">Sweden</option> <option value="CH">Switzerland</option> <option value="SY">Syrian Arab Republic</option> <option value="TW">Taiwan</option> <option value="TJ">Tajikistan</option> <option value="TZ">Tanzania</option> <option value="TH">Thailand</option> <option value="TL">Timor-Leste</option> <option value="TG">Togo</option> <option value="TK">Tokelau</option> <option value="TO">Tonga</option> <option value="TT">Trinidad / Tobago</option> <option value="TN">Tunisia</option> <option value="TR">Turkey</option> <option value="TM">Turkmenistan</option> <option value="TC">Turks and Caicos Islands</option> <option value="TV">Tuvalu</option> <option value="UG">Uganda</option> <option value="UA">Ukraine</option> <option value="AE">United Arab Emirates</option> <option value="GB">United Kingdom</option> <option value="UM">United States Minor Outlying Islands</option> <option value="UY">Uruguay</option> <option value="UZ">Uzbekistan</option> <option value="VU">Vanuatu</option> <option value="VE">Venezuela</option> <option value="VN">Viet Nam</option> <option value="VG">Virgin Islands, British</option> <option value="VI">Virgin Islands, U.S.</option> <option value="WF">Wallis and Futuna</option> <option value="EH">Western Sahara</option> <option value="YE">Yemen</option> <option value="ZM">Zambia</option> <option value="ZW">Zimbabwe</option> </select> </li> <li class="zipcode"> <label for="zip">Zip / Postal Code:</label> <input type="text" name="zip" id="zip" value="" maxlength="5"/> </li> </ul> <p>*You must be at least 13 years of age to register for an account.</p> </div> <div class="submit section"> <h2>3. 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